Bhamashah Swasthya Bima Yojana-BSBY Rajasthan

March 9, 2021

[BSBY Rajasthan] What is Bhamashah Swasthya Bima Yojana Rajasthan? How to avail BSBY?

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Bhamashah Swasthya Bima Yojana (BSBY): – Bhamashah Health Insurance Scheme has been launched for the state’s citizens by Smt. Vasundhara Raje Scindia Chief Minister Rajasthan.

The Rajasthan government has launched this health insurance scheme to provide cashless service to IPD patients in government and listed private hospitals to about one crore of selected families.

Only persons associated with National Food Security Act (NFSA) and National Health Insurance Scheme (RSBY) can apply under Bhamashah Health Insurance Scheme.

Health insurance cover common ailments	₹ 30000
Health insurance cover critical illnesses	₹ 300000
Pre-hospitalization expenses	Up to 7 days
Post-hospitalization expenses	Up to 15 days
Transport allowance for poly-trauma and cardiovascular diseases	Up to ₹ 100 – ₹ 500

Bhamashah Health Insurance Scheme is a type of cashless facility for IPD patients. The state government announced the scheme in the 2014-15 fiscal year. Only the people of Rajasthan can get the benefit of this scheme.

Families under the National Health Insurance Scheme and the National Food Security Act can benefit from Bhamashah Health Insurance Scheme. For families connected to the BSBY scheme, the premiums paid in advance are paid annually based on floater policy.

The state government has selected the New India Insurance Company as an insurer based on a two-stage open competition for the Bhamashah Swastha Bima Yojana.

Table of Contents

Bhamashah Health Insurance Scheme Key Points

Portal Name	Bhamashah Swasthya Bima Yojana Portal
Launched by	Smt Vasundhara Raje Scindia, Chief Minister of Rajasthan
Tagline	Dedicated to the people, the Rajasthan government should provide better health and treatment to all.
Related Departments	Department of Medical, Health and Family Welfare, Government of Rajasthan.
Beneficiary	Citizens of Rajasthan who are covered under the National Food Security Act and National Health Insurance Scheme.
Objective	To provide cashless treatment facilities to IPD patients from low-income families of Rajasthan.
Portal Designed, Developed & Maintained by	National Information Center Rajasthan Unit
Official website	Click Here

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Bhamashah Swasthya Bima Yojana Portal

The Department of Medical, Health, and Family Welfare, Government of Rajasthan has launched the Bhamashah Swasthya Bima Yojana portal for smooth implementation of Bhamashah Swasthya Bima Yojana.

Citizens of Rajasthan holding Bhamashah cards can avail themselves of benefits by applying online for health insurance schemes using this portal. On the Bhamashah Swasthya Bima Yojana portal, all kinds of information related to insurance schemes and orders of governance can be obtained.

Detailed information is also provided on the portal for applying and the documents required for the application. Under Bhamashah Swasthya Bima Yojana, 1045 types of packages have been provided to patients for common ailments.

The benefits of these packages can be availed through private health institutions and public health institutions. In government hospitals, 170 packages are provided under common diseases and 500 packages under critical illness.

The cost of these packages includes bed fees, surgeon advisory fees, anesthetic fees, boarding and nursing fees, blood, consumables, transplants, anesthesia, medicines, X-rays, cost of diagnosis, and radiological tests like urine test, blood, etc.

Apart from this, transportation allowance, allowance for cardiac-related cases and food charges during hospitalization are also included.

The purpose of Bhamashah Swasthya Bima Yojana

The following objectives are enshrined in the Bhamashah Swasthya Bima Yojana launched by the Rajasthan government for the state’s poor citizens.

Under this scheme, additional expenses have to be reduced by providing financial cover to the sick person.
Bhamashah Swasthya Bima Yojana’s main goal is to reduce the burden of additional expenses due to illness by providing insurance cover to low-income families.
Under the scheme, the state government is creating a health database so that policy-level decisions and changes related to health can be made in the future.
The state government wants to revolutionize health services in rural areas through this scheme.
The state government wants to encourage the private sector under hospitalization services, reducing government facilities’ growing concerns.
The cost incurred by the Government of Rajasthan on medical facilities has been reduced through insurance.
The Rajasthan government wants to provide opportunities for medical facilities to citizens in high-level private hospitals as well.

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Bhamashah Swasthya Bima Yojana Eligibility Conditions

The applicant must be a permanent resident of Rajasthan; that is, the original domicile certificate of Rajasthan is required.
The beneficiary can be the head of the family’s spouse, and the parents dependent on the beneficiary will join the scheme.
If a person’s name is mentioned in the Bhamashah card as a member of the family, he will also benefit from this scheme.
Children of the beneficiary family can benefit from this scheme till the age of 25 years or in the event of getting employment, whichever is earlier.
If a person’s name is in the National Food Security Act and Rashtriya Swasthya Bima scheme list, then he is entitled to get the benefit of this scheme.
Applicants must have a Bhamashah Card. If a person does not have a Bhamashah card, he has to produce documents related to the National Food Security Act and the Rashtriya Swasthya Bima scheme.
The applicant belongs to the poorer section of the society, who is the holder of the BPL card.

Bhamashah Swasthya Bima Yojana Package Services

Under Bhamashah Swasthya Bima Yojana, the following medical facilities will be available to the beneficiary family under the general ward.
Bed expenses in the general ward.
The cost of recruitment and nursing in the general ward.
Surgery, anesthesia specialist, and general medical consultation fees.
Expenses on anesthesia, anesthesia, blood, and oxygen.
Cost of equipment and medicines used in operation.
Transplant equipment, x-rays, and testing costs.

Service Providers under Bhamashah Swasthya Bima Yojana

The institutions that provide service under Bhamashah Swasthya Bima Yojana are as follows.

All community health centers and all high-level state medical institutions.
Privately selected/listed private hospitals by the insurance company and the state government. (List of listed private hospitals)
All state-run private medical institutions under Rashtriya Swasthya Bima Yojana (List of listed hospitals)
All medical institutes included in Rashtriya Swasthya Bima Yojana are included in Bhamashah Swasthya Bima Yojana.
Private hospitals will also be included from time to time based on the criteria jointly decided by the State Health Insurance Agency and the insurance company.

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Benefits and features of Bhamashah Swasthya Bima Yojana

Families associated with National Food Security Act and Rashtriya Swasthya Bima Yojana can benefit from Bhamashah Health Insurance Scheme launched by the Rajasthan Government. Identification of such families is done through Bhamashah Cards. People are getting the following benefits from Bhamashah Swasthya Bima Yojana.

Under the scheme, the claim process and other demands have been standardized for hospitals to eliminate any corruption.
Medical protocols have been verified and well defined by the state government.
A mobile application has been prepared for all the officers of the district connected with the Health Department.
Effective monitoring mechanisms have been implemented by removing the TPA system to reduce the leakage to prevent further cost overruns in the health plan.
Low-income families have been provided an opportunity to contact private health institutions for availing health services under the scheme.
The implementation of the scheme has reduced the burden on government health institutions.
Financial reforms have been made in the Medical Relief Society of Government Health Institutions.
Under the Bhamashah Swasthya Bima Yojana, each eligible family has been provided an insurance cover of ₹ 30000 for general diseases and ₹ 300000 for critical illnesses every year.
The scheme’s beneficiaries will get all the facilities cashless, and the beneficiaries can get these health facilities from community health centers, high-level state medical institutions, and listed private hospitals.
The unutilized amount of available cover will be automatically canceled at the end of the plan year period.
Apart from hospitalization, the expenditure for 7 days before and 15 days after the hospitalization has also been included.
So far, more than 1700 diseases have been covered under this scheme.
Under Bhamashah Swasthya Bima Yojana, more than 300 special treatment packages, including psychiatry, gastrology, nephrology, and neurology, have been added.
The distribution of OPD and cashless medicines has also been started on a large scale under this scheme by the state government.
Under this scheme, medicines, various tests, doctor’s fees, treatment expenses, operation expenses, food preparation expenses during hospitalization, etc., are included.
Under this scheme, families under the National Food Security Act and Rashtriya Swasthya Bima Yojana have also been included.
To avail of the scheme, the applicant is a permanent resident of Rajasthan and must have a Bhamashah card.
Under Bhamashah Swasthya Bima Yojana, all the diseases before the insurance of all the insured family members will be covered under it.
The scheme covers travel allowance up to ₹ 100- ₹ 500 in case of heart disease and polytrauma.
An additional fund of 10 crores has also been made for this scheme by the state government. If the entire sum assured of the beneficiary is exhausted or in case of a shortfall, the expenses will be provided after the status of the patient, after being approved by the competent authority.
Bhamashah Swasthya Bima Yojana provides complete protection to the insured’s family, i.e., it includes treatment of common ailments and serious ailments.
This scheme’s benefit can be availed from any listed private or government hospital through the claim on the package rates.
In this scheme, from about 1700 packages (i) 1045 for general diseases, (ii) 500 for serious diseases, (iii) 170 reserved packages for state medical institutions, etc., have been included.

Guide to Bhamashah Swasthya Bima Yojana

There is also a provision by the state government to provide guides to every health institution under the scheme, for patient assistance, for Bhamashah Swasthya Bima Yojana’s successful operation initiated by the Government of Rajasthan.

This guide will assist in identifying the patient, information on available insurance amount, assistance in providing treatment to the patient in the health institution, discharge and follow up of the patient, etc. Government or private hospitals listed in Bhamashah Swasthya Bima Yojana will have to appoint health guides based on patients’ numbers.

The hospital is required to appoint one health guide per 50 average OPDs according to the OPD load. Additional guides have to be appointed on more than 50 OPDs. Guides will be paid an honorarium by RMRS.

Guide’s educational qualifications

The mentor must be a graduate.
The guide must be a resident of the hospital area.
A mentor must have good communication skills (skilled at talking).
Must be ready to move to the surrounding areas/villages.
The guide is required to know computer-related work.

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Guide functions

The health guide will ensure the identity of the beneficiary. The guide will use the Bhamashah & Aadhaar cards’ biometric data to ensure the identity of the beneficiary.
If a beneficiary does not have a Bhamashah card. In that case, the health guide will upload a copy of the documents related to the patient’s National Food Security Act and Rashtriya Swasthya Bima Yojana into the software through a scan, and the MOIC will check and verify it.
The health guide will upload the photo of the beneficiary after the identification is ensured.
Once the identification is ensured, the beneficiary will block the amount. If any disease is not included in the insurance scheme package. In that case, the beneficiary will be sent to provide the facility based on the Chief Minister’s Free Investigation Scheme and the Chief Minister’s Free Drug Scheme.
If there is no arrangement for treating a disease in that hospital, then the health guide will refer it to another hospital where treatment of that disease is available.
If the package is blocked in the concerned medical institution before referring the sick person to another hospital. In that case, the MOIC will be unlocked for another medical institute based on a referral slip, and its information will be sent to the next institute through software.
The health guide will enter the referred hospital’s name in the software and transfer the patient’s records to the hospital through the software.
Suppose the patient leaves without informing the guide during treatment. In that case, his / her expenses will be determined based on the physician’s post-operative cost, which will be scanned and uploaded into the software and verified by the Medical Officer in Incharge.
Once the patient is fully recuperated, his treatment documents will be uploaded on the system by the guide.
Computer, printer, scanner, 2 Mbps broadband connection with 30 minutes backup will be provided by the concerned hospital to work the health guide.

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Bhamashah Swasthya Bima Yojana Claim Process

Bhamashah Swasthya Bima Yojana, started by the Rajasthan government, can only be availed only by the families associated with the National Food Security Act and the National Health Insurance Scheme. Identification of such families is done through Bhamashah Cards. The benefit of Bhamashah Swasthya Bima Yojana can be obtained as follows.

Under Bhamashah Health Insurance Scheme, the beneficiary will have to present the Bhamashah Card or the identity card related to the National Health Insurance Scheme to the Health Guide for availing medical facilities.
The health guide will register the software based on the biometric information of the patient’s Aadhar card.
If the patient is to be admitted to the hospital, a prescription for the doctor’s advice will have to be provided to the guide. The guide will reserve the patient’s treatment package based on the biometric details of the patient’s Aadhar card.
In case of treatment of secondary packages, the test report, treatment slip, discharge summary, etc., have to be uploaded in the software, verified by the insurance company’s representative, and ask the hospital to present any document.
In Tertiary packages, the hospital will have to first apply through the portal to the insurance company. If the insurance company cannot verify within 48 hours, it will be deemed that the company has accepted it.
In this situation, the insurance company can do any query from the hospital in 6 hours, and the hospital will have to reply within 4 hours. The insurance company can do a maximum of 3 times in 48 hours, and the hospital is required to respond to every query every 4 hours.
If there is a dispute in this regard, the District Level Grievance Redressal Committee will decide it.
To get the benefit of Bhamashah Swasthya Bima Yojana, the beneficiary has to match his biometric/other identities.
In the event of surgery, the patient will have to provide pre-medical and post-surgery photographs to the hospital’s insurance company.
Real-time data will always be available for monitoring for all parties. The insurance company will have to make daily reports available on the web portal.
The hospital will submit the bill of treatment to the insurance company, and the insurance company will pay the claim to the hospital within a maximum of 21 days. If any hospital bill remains, then it will be the responsibility of the insurance company.

Important download link related to Bhamashah Swasthya Bima Yojana

List of hospitals from Bhamashah Swasthya Bima Yojana

Also Read:- What is the benefits of Bhamashah Card